Hi,I am 23 years old. For the past 2 years I have been having pain right above my left breast. It hurts to bend forward....I must sit back. Also during these episodes I constantly feel the need to burp. When I burp I feel relief. I usually do not have heartburn. I did an EKG about 3 months ago, which was normal. My worry is that I am overweight and have mitral valve prolaps. I also have anxiety disorder. My pcp keeps reassuring me that there is nothing to worry about, however, I cant shake the feeling that something is wrong. Please give me your opinion.

First, the good news: the pain can be duplicated by postural changes (bending forward), and occurs in the wrong area for heart pain if isolated to this location, so we can set aside the heart concerns (mitral valve prolapse isn't usually a proper disease of the heart anyway, but we'll get back to that). Secondly, if burping relieves the pain it is also another disqualifier for heart disease. One can have gas trapped -- often at a distance from the location of referred pain in fact -- and not only will it cause pain in the area you describe, but leaning forward can make it worse, especially in people who are even a little bit overweight. Burping, again, relieving the gas pressure, also relieves the pain.

Now then, for the bigger concerns: you describe yourself as having anxiety disorder. This is a far bigger problem than any of the physical symptoms it can sometimes cause or mimic, and can really hamper your enjoyment of life. So this needs some work. Also, you have been diagnosed with mitral valve prolapse (MVP). While this, in itself, is very rarely serious (and is often considered a variant of normal), it is frequently associated with anxiety and panic disorder, for reasons that are not entirely clear. People with MVP also more often have unexplained sharp, sticking chest pains, occasional shortness of breath (but usually good exercise tolerance), and sometimes fatique. Also acid reflux, with or without heartburn. Regular exercise and adequate hydration tend to help with these symptoms a lot. There are others that sometimes show up in people with MVP as well, and they usually are suggestive of heart disease, but almost never does any actually turn up.

So the good news is your chest pains don't resemble heart pains at all, but you are anxious about them anyway, and that's normal -- at least if you can now let them go. However, anxiety is a very unpleasant feeling and while it can be managed very well, it does take some work on the part of the patient.

I hope all this is helpful, and if you have additional questions please do follow up with us here.